Chronic non‐cancer pain and the epidemic prescription of opioids in the Danish population: trends from 2000 to 2013

Abstract

The use of opioids has increased in Denmark, especially among elderly women. The concurrent use of BZD/BZD-related drugs has decreased from 2010 to 2013, but still one-third of long-term opioid users were co-medicated.

Tolerance and cross-tolerance to the antinociceptive effects of oxycodone and the imidazoline I2 receptor agonist phenyzoline in adult male rats

“…However, clinical opioid use for the treatment of chronic pain is limited because: (1) opioids are not effective for some chronic pain conditions such as certain neuropathic pain (Smith 2012); (2) prolonged opioid use can lead to various clinically significant adverse effects such as tolerance and physical dependence, which at least partially contribute to the recent opioid epidemic (Birke et al 2016; Manchikanti et al 2016; Rudd et al 2016). Therefore, the development of new combination therapy that reduces opioid use and tolerance may have substantial clinical significance.…”

Gasto, prescripción y consumo de analgésicos antes y durante la crisis económica

“…Los opiáceos son considerados, según la escala analgésica de la Organización Mundial de la Salud (OMS), medicamentos indicados para paliar el dolor de intensidad moderada y severa (15), habiendo sido fomentada su utilización en numerosos estudios (16,17). Asimismo, algunos estudios han demostrado que el aumento de consumo de opioides está directamente relacionado con una mayor prevalencia de DC en la población (18). Este hecho también podría explicar nuestros resultados, ya que aunque no se dispone de la prevalencia de dolor crónico en estos años en el distrito sanitario objeto de estudio, es conocido que la prevalencia de dolor crónico en España ha sufrido un aumento en los últimos años pasando del 12 % en 2006 (9) al 16,6 % en 2014 (19).…”

Liberal long‐term opioid prescription – more pain than gain?

“…Al Dabbagh et al 1 observe that an unexpectedly high percentage of patients, 45%, continue to receive dispensed opioid prescriptions for more than 6 months after their injury and operative intervention, and more than a third continue opioid treatment for at least 12 months. Birke et al 3 show that in Denmark, the consumption of opioids which already was very high, has continued to increase with 38% from 2000 to 2013. Birke et al 3 show that in Denmark, the consumption of opioids which already was very high, has continued to increase with 38% from 2000 to 2013.…”

“…4,5 In chronic severe pain, a common principle is that potent opioids should be prescribed as a mainstay of treatment to patients with a short lifetime expectancy, and only in exceptional cases in this way to patients with chronic noncancer pain. 3,6,7 Understandably, this is interpreted by many physicians as evidence that opioids are generally effective and acceptable in chronic pain management. Some guidelines even suggest the use of weak opioids as firstline treatment, and strong opioids as secondline treatment for chronic non-cancer pain.…”

“…As a result, common practice appears to have moved far from the original strategies and precautions; opioids are no longer prescribed only in exceptional cases to patients with chronic non-malignant pain, but instead are prescribed regularly, and without needed follow-up. 3,13 A liberal opioid prescription policy results in an increased societal opioid-exposition and dramatically increases the risks for abuse, addiction, non-medical use, increased morbidity, serious events and even death. 9,10 Among the Nordic countries, Denmark has had the most liberal opioid prescription policy during the last several decades.…”